Expectations for today's NHS have vastly overtaken the service's original remit over 50 years ago.

Niall Dickson explains how this unique institution has changed over the years and the huge challenges it now faces.

The NHS has been described as one of the greatest social achievements of the 20th century with its promise to care for the British people from cradle to grave.

In a sense, that promise remains - but the health service that was launched on 5 July 1948 bears little resemblance to the multi billion pound operation that dominates our public sector today.

Transplant surgery, chemotherapy and a vast array of other new therapies and treatments - these were all for the future.

And as it has changed, so too have we.

For most of us, the National Health Service is something we take for granted.

Yet just over 50 years ago the cost of medical care was a source of real worry to many families and something which some simply could not afford.

We expect more from our health care system than ever

Niall Dickson

At the end of the Second World War everyone agreed something had to be done and the answer came in the form of a state funded National Health Service - a key strand of the 1945 Atlee government's post-war reconstruction.

It was a controversial model but one which soon became accepted, in broad terms, both by politicians and professionals.

'Crisis' time?

Between 1948 and 1974 the NHS was largely unchanged. Since then, both Labour and Conservative governments have chopped and changed the landscape of health in this country.

But one principle has remained: that the NHS should be funded from general taxation and available to all free at the point of use.

Skip forward to today and, according to some, the NHS is in crisis.

In spite of huge sums of extra money, the critics point to an overblown bureaucracy, unresponsive services and too much political control.

CHANGES SINCE 1997

50,000 more nurses

14,000 more doctors

But some of the above figures may represent new part timers replacing old full timers

68 major new hospitals, either built or about to open in the next few years (some of the earlier ones will have been started under the Conservatives)

The challenges are certainly great.

We expect more from our health care system than ever - more of us want to be treated in accident and emergency departments, more of us need operations, and more of us want more time with family doctors.

Add to all that more than 17 million people in the UK who suffer from long-term chronic diseases such as asthma and heart disease, not to mention huge and unprecedented rises in obesity and diabetes as well as worrying increases in sexually transmitted disease, and it is clear the demands can only grow in the coming years.

The BBC's Your NHS picks up on some of these themes.

As part of the BBC One programme on 24 March, an audit carried out by the King's Fund assesses how far the government has progressed in the five key health priorities viewers voted for on the last NHS day two years ago.

They were free long-term care for the elderly, more pay for NHS staff, improved A&E, reduced waits for heart and cancer treatment and cleaner hospitals.

Progress costly

So how far has the government progressed in each of these areas?

CHANGES IN THE LAST 20 YEARS

80 per cent more inpatients and day cases treated

20 per cent more outpatients treated

30 per cent more emergencies treated

70 per cent more prescriptions issued

Average waiting times reduced from ten to three months

Life expectancy increased by five years

8 per cent overall drop in death rates

Our research paints a largely positive picture with improvements in all areas, although in some ways it is too early to judge whether the extra resources the government has put into the NHS are delivering value for money.

Any progress in the last two years has of course come at a price.

The 2002 Budget provided the largest ever sustained increase in NHS funding - an average annual increase in real terms of 7.4 per cent between 2002/3 and 2007/8.

This will take total net NHS expenditure from £55.8 billion to £90.2 billion over five years.

This should mean the largest growth in capacity in the history of the NHS.

Opportunity or threat?

The next challenges for the NHS - and indeed for us all - may be rather different.

We face a continuing challenge to reduce the levels of health inequalities which have persisted and increased

Niall Dickson

For good and obvious reasons we have been interested in treating and caring for the sick and that must remain a key priority in any civilised society.

But we now face both a threat and an opportunity in the rising tide of preventable disease and ill health caused in large part by modern lifestyles.

And we face a continuing challenge to reduce the levels of health inequalities which have persisted and increased even under our universal healthcare system.

These threats to the health of our nation will not resolve themselves.

They will require new and imaginative responses and concerted action not just on the part of the NHS but by government, by organisations public and private, and by individuals themselves.

Niall Dickson appeared on the programme Your NHS: For Better or Worse, broadcast at 21:00 GMT on Wednesday, 24 March, 2004 on BBC One.